Factors to Support Effective Discharge Decision Making

描述：每年有超过1200万人次出院转诊 为医疗保险接受者做出决定，但没有全国性的， 经验得出的临床指南，以帮助使这些重要 决定。出院转诊决策质量为负 受逗留时间缩短、评估标准不一致以及 决策中的专业知识水平和风险承受能力各不相同。这些 因素可能会导致弱势老年人的出院，他们将经历 代价高昂，出院结果不佳。这项研究的目的是：1)捕捉 专家在创建供以下机构使用的决策支持系统方面的知识 护士和其他临床医生在作出出院转诊决定时 对于年龄较大的患者，2)比较专家的出院转诊率 系统对护士和其他医院临床医生的转诊率和 专家，以及3)检查专家系统与 临床医生转诊或不转诊患者进行随访的决定 患者出院后的转归。研究的具体目的是：1) 确定支持护士和其他临床医生的因素的层次 关于出院后后续跟进的转介决策 住院的老年人，和2)比较敏感性和特异性 具有出院转诊决策的专家决策支持系统， 针对老年人，由出院计划专家、护士和其他人员制定 临床医生。四名国家认可的多学科学者和四名 多学科、临床专家将参与知识丰富的 启发式会议，以解释应该是 在作出出院转诊决定时予以考虑。一个决定 分析方法论将指导使用各种知识的启发 技巧。利用层次分析法，专家们将对 一系列与决定转介 对特定患者进行出院后随访。专家系统将是 放置在专家外壳中，使用以下案例研究进行验证和测试 住院的老年人来自一个正在进行的和 NINR资助的两项已完成的临床试验。已确定的出院转诊率 将专家系统与临床医生和专家的推荐进行比较 专家确定的老年人的发病率和出院后结果 转介系统将与 系统不需要转介。这项研究具有重要的临床意义。 这意味着什么。研究结果将确定并提供关于 专家规范和便利有需要的患者的识别 出院后随访。结果还可能提高质量和一致性 ，减少评估所需的时间，并减少 与不良结果相关的费用与未得到满足的出院后需求有关。

DESCRIPTION: Each year more than 12 million hospital discharge referral decisions are made for Medicare recipients, yet there are no national, empirically derived clinical guidelines to assist in making these important decisions. The quality of discharge referral decision-making is negatively affected by shortened lengths of stay, inconsistent assessment criteria, and varying levels of expertise and risk tolerance in decision-making. These factors may result in the discharge of vulnerable elders who will experience costly, poor discharge outcomes. The study's purposes are: 1) to capture the knowledge of experts in the creation of a decision support system to be used by nurses and other clinicians while making hospital discharge referral decisions for older patients, 2) to compare the discharge referral rates of the expert system to the referral rates of nurses and other hospital clinicians and experts, and 3) to examine the relationship of the expert system's and clinicians' decisions to refer or not to refer patients for follow up with patients' post-discharge outcomes. The specific aims of the study are: 1) to identify a hierarchy of factors to support nurses and other clinicians' decision making regarding referrals for post-discharge follow-up for hospitalized older adults, and 2) to compare the sensitivity and specificity of an expert decision support system with hospital discharge referral decisions, for older adults, made by discharge planning experts, nurses and other clinicians. Four nationally recognized multidisciplinary scholars and four multidisciplinary, clinical experts would participate in knowledgeable elicitation sessions to explicate the hierarchy of factors that should be considered when making hospital discharge referral decisions. A decision analysis methodology will guide the use of a variety of knowledge elicitation techniques. Using the analytic hierarchy process, experts will weight the importance of a range of factors in relation to the decision to refer a particular patient for post-discharge follow-up. The expert system will be placed into an expert shell, validated and tested using case studies of hospitalized older adults derived from the control groups of one ongoing and two completed NINR funded clinical trials. Discharge referral rates identified by the expert system will be compared with clinicians' and experts' referral rates and post-discharge outcomes of older adults identified by the expert system for referral will be compared to the older adults identified by the system as not needing a referral. The research has important clinical implications. Study findings will identify and make available the knowledge of experts to standardize and facilitate the identification of patients in need of post-discharge follow-up. Results may also improve the quality and consistency of referral decisions, reduce the time required for evaluation, and decrease the costs associated with poor outcomes related to unmet post-discharge needs.